3-17 Examination report (to determine capacity), Juvenile Delinquency Forms (Family Court Act Article 3), Subchapter A. Forms Authorized by Section 205.7, Chapter IV. Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7), Subtitle D. Forms, TITLE 22. Judiciary, New York Codes Rules Regulations

New York Codes Rules Regulations (Last Updated: March 27,2024)

Chapter IV. Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7)

Subchapter A. Forms Authorized by Section 205.7

Juvenile Delinquency Forms (Family Court Act Article 3)

3-17 Examination report (to determine capacity)

Secs. 301.2, 322.1 F.C.A.

Form 3-17

(Juvenile Delinquency)

7/83

TO THE FAMILY COURT OF THE STATE OF NEW YORK

COUNTY OF _________

________________

In the Matter of

Docket No. __

______

EXAMINATION REPORT

(To Determine Capacity)

A Person Alleged to be a

Juvenile Delinquent,

______ Respondent.

________________

__ a duly (qualified psychiatrist) (certified psychologist) hereby reports as follows:

1. I examined __, the Respondent herein, pursuant to an order of the Court dated __, 19 , to determine whether Respondent is (mentally ill) (mentally retarded or developmentally disabled)

on (date) __ at (location) __

2. Based upon the above examination(s), in my professional judgment, __ (is) (is not) an incapacitated persons as defined in subdivision (13) of section 301.2 of the Family Court Act.

3. I base this opinion upon the following

a. Diagnosis

b. Prognosis

4. The following is a detailed statement of the reasons for my opinion:

[Make particular reference to those aspects of the proceedings wherein Respondent lacks capacity to understand or to assist in defense.]

Dated: ______, 19.

______________

(Qualified Psychiatrist) Signature

(Certified Psychologist)